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Pediatr Nephrol. 2018 Jun;33(6):1069-1077. doi: 10.1007/s00467-018-3888-4. Epub 2018 Mar 6.

Kidney injury biomarkers 5 years after AKI due to pediatric cardiac surgery.

Author information

1
Department of Pediatrics, Section of Nephrology, Yale University School of Medicine, New Haven, CT, USA. jason.greenberg@yale.edu.
2
Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT, USA. jason.greenberg@yale.edu.
3
Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
4
Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT, USA.
5
Department of Pediatrics, Division of Cardiology, Stanford University School of Medicine, Stanford, CA, USA.
6
Department of Internal Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT, USA.
7
VA Medical Center, West Haven, CT, USA.
8
Department of Pediatrics, Division of Nephrology, Toronto Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. michael.zappitelli@sickkids.ca.

Abstract

BACKGROUND:

We previously reported that children undergoing cardiac surgery are at high risk for long-term chronic kidney disease (CKD) and hypertension, although postoperative acute kidney injury (AKI) is not a risk factor for worse long-term kidney outcomes. We report here our evaluation of renal injury biomarkers 5 years after cardiac surgery to determine whether they are associated with postoperative AKI or long-term CKD and hypertension.

METHODS:

Children aged 1 month to 18 years old undergoing cardiopulmonary bypass were recruited to this prospective cohort study. At 5 years after cardiac surgery, we measured urine interleukin-18, kidney injury molecule-1, monocyte chemoattractant protein-1, YKL-40, and neutrophil gelatinase-associated lipocalin (NGAL). Biomarker levels were compared between patients with AKI and those without. We also performed a cross-sectional analysis of the association between these biomarkers with CKD and hypertension.

RESULTS:

Of the 305 subjects who survived hospitalization, four (1.3%) died after discharge, and 110 (36%) participated in the 5-year follow-up. Of these 110 patients, 49 (45%) had AKI. Patients with versus those without postoperative AKI did not have significantly different biomarker concentrations at 5 years after cardiac surgery. None of the biomarker concentrations were associated with CKD or hypertension at 5 years of follow-up, although CKD and hypertension were associated with a higher proportion of participants with abnormal NGAL levels.

CONCLUSIONS:

Postoperative pediatric AKI is not associated with urinary kidney injury biomarkers 5 years after surgery. This may represent a lack of chronic renal injury after AKI, imprecise estimation of the glomerular filtration rate, the need for longer follow-up to detect chronic renal damage, or that our studied biomarkers are inadequate for evaluating subclinical chronic renal injury.

KEYWORDS:

Acute kidney injury; Biomarker; CKD; Cardiopulmonary bypass; Children; Long-term outcomes

PMID:
29511889
PMCID:
PMC5945328
[Available on 2019-06-01]
DOI:
10.1007/s00467-018-3888-4

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